RESUMO
The objective of this study is to report the surgical outcome after middle fossa approach (MFA) plugging in patients suffering from a superior semi-circular canal dehiscence (SCD) syndrome. This is a retrospective case review. Tertiary referral center. Sixteen ears in 13 patients with a SCD syndrome suffering from severe and disabling vestibular symptoms with a bony dehiscence on CT scan >3 mm and decreased threshold of cervical vestibular evoked potentials (cVEMPs). We assessed preoperatively: clinical symptoms, hearing, cVEMPs threshold, size of dehiscence and videonystagmography (VNG) with caloric and 100 Hz vibratory tests. Postoperatively, we noted occurrences of neurosurgical complication, evolution of audiological and vestibular symptoms, and evaluation of cVEMP data. Tullio's phenomenon was observed in 13 cases (81.3 %) and subjectively reported hearing loss in seven (43.7 %). All patients were so disabled that they had to stop working. No neurosurgical complications were observed in the postoperative course. In three cases (16.6 %), an ipsilateral and transitory immediate postoperative vestibular deficit associated with a sensorineural hearing loss (SNHL) was noted, which totally resolved with steroids and bed rest. All patients were relieved of audiological and vestibular symptoms and could return to normal activity with a mean follow-up of 31.1 months (range 3-95). No patient had residual SNHL. cVEMPs were performed in 14 ears postoperatively and were normalized in 12 (85.7 %). Two of the three patients operated on both sides kept some degree of unsteadiness and oscillopsia. MFA plugging of the superior semi-circular canal is an efficient and non-hearing deteriorating procedure.
Assuntos
Perda Auditiva Neurossensorial , Procedimentos Cirúrgicos Otológicos , Complicações Pós-Operatórias , Canais Semicirculares , Vestíbulo do Labirinto , Adulto , Audiometria/métodos , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/instrumentação , Procedimentos Cirúrgicos Otológicos/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Canais Semicirculares/patologia , Canais Semicirculares/cirurgia , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/etiologia , Doenças Vestibulares/cirurgia , Testes de Função Vestibular/métodos , Vestíbulo do Labirinto/patologia , Vestíbulo do Labirinto/cirurgiaRESUMO
BACKGROUND: The purpose of this study was to assess the accuracy of (18) F-fluorodeoxyglucose positron emission tomography ((18) FDG PET)-CT in detecting residual or recurrent disease after nonsurgical treatment for head and neck squamous cell carcinoma (HNSCC). METHODS: We conducted a retrospective analysis of patients with oral cavity, oropharynx, larynx, hypopharynx, or cervical lymph node location of SCC treated with chemoradiotherapy. Twelve weeks posttreatment, (18) FDG PET-CT results were compared to histology if residual disease was suspected. Patients with complete response received a minimum of 24-month follow-up. RESULTS: Forty-seven patients were included with 40 months of median follow-up: 46 with a squamous cell carcinoma (SCC) at the primary site and 43 in the neck. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 86.7%, 90%, 76.5%, and 93.1%, respectively, at the primary site and 100%, 97.2%, 87.5%, 100%, respectively, in the neck. CONCLUSION: (18) FDG PET-CT seems effective in detecting residual disease and in predicting recurrent disease within the first 2 years of follow-up after nonsurgical treatment. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1271-E1276, 2016.
Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Quimiorradioterapia , Feminino , Fluordesoxiglucose F18 , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasia Residual/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
Patients undergoing percutaneous endoscopic gastrostomy (PEG) for pharyngoesophageal malignancies are subject to develop malignant seeding at the PEG stoma. Risk factors include an untreated or recurrent advanced stage squamous cell carcinoma at the time of the PEG procedure and an endoscopic pull-string gastrostomy. Diagnosis is frequently late because this rare complication is poorly known. Prognosis remains poor despite aggressive treatment. Physicians should be aware of this complication in the event of hypermetabolic uptake around or close to a PEG stoma in patients monitored for a pharyngoesophageal squamous cell carcinoma.